AMD affects an area of your eye called the macula. The macula is a tiny area in the centre of your retina at the back of your eye. When light enters your eye, it’s directed onto your retina. Your retina sends nerve signals to your brain that are interpreted as visual images. The macula is responsible for your central vision (when you're looking directly at something). It allows you to see clearly and in fine detail and colour.
In AMD, the cells in your macula start to become damaged and stop working properly. This leads to a gradual loss of your central vision.
In the early stages of AMD, you may have some minor damage to cells in your eye, or a build-up of protein deposits called drusen. You may not even notice any vision loss at this stage.
If your AMD progresses, it can be classified as one of two types.
- Dry AMD. This is the most common type. It affects around nine in every 10 people with AMD. In dry AMD, you have an increasing build-up of drusen deposits in your eye, and further damage to cells. This causes your central vision to gradually get worse, usually over many years.
- Wet AMD. This affects around one in every 10 people with AMD. In wet AMD, new blood vessels start to grow behind your retina. These blood vessels can leak and cause scarring. If you have wet AMD, you may lose some or all of your central vision very quickly – within weeks or months.
Sometimes, people who start with dry AMD progress to wet AMD.
AMD doesn’t always cause symptoms at first, but it can be picked up at a routine appointment with an optometrist. An optometrist is a registered health professional who examines eyes, tests your sight, and dispenses glasses and contact lenses. So, it’s important to go for routine eye tests, even if your vision seems fine.
AMD isn’t painful and you may not notice any symptoms at first. The symptoms vary from person to person. Common symptoms include the following.
- Worsening vision – you may find it increasingly difficult to do things like read and drive. This can be gradual, or sudden. You may become unable to recognise fine details such as facial expressions.
- Distorted vision – straight lines can become wavy or bent.
- Light glare – you may find it difficult to see properly around bright lights, such as car headlights or bright sunshine.
- Seeing a dark patch in your central field of vision.
- Finding it hard to tell the difference between different shades of a colour.
- Having difficulty adjusting to dark or dim lighting.
- Seeing flickering or flashing lights.
- Visual hallucinations (seeing things that aren't really there).
If you notice any of these symptoms, book an appointment with an optometrist as soon as you can. If your symptoms are getting worse before you can be seen by an optometrist, go to your nearest Eye Casualty or Accident and Emergency department (A and E) as soon as you can. If your symptoms are caused by wet AMD, getting treatment as quickly as you can, may help stop you losing your sight.
When you see an optometrist, whether for a routine check, or because you're having symptoms, they will do some initial tests to check your eyes. These may include examining the inside of your eyes for signs of damage using an ophthalmoscope (a hand-held device with a light on the end). Your optometrist may also check your vision by asking you to read a number of letters that decrease in size on a chart.
Your optometrist may ask you to do another test to check your central vision using an Amsler grid. This is a printed grid with a dot in the middle of it. You hold the grid at a comfortable reading distance, and look at the dot with one eye at a time. You will be asked if you can see all four corners of the grid, and whether any of the lines are missing or distorted (out of shape).
Referral to an ophthalmologist
An ophthalmologist is a doctor trained in diagnosing and treating eye conditions. If your optometrist thinks you may have AMD, they will refer you to an ophthalmologist for further investigations. If they suspect you may have wet AMD, you should be given an urgent referral to be seen within two weeks. Early treatment for this type of AMD can stop you losing your vision.
Your ophthalmologist may suggest you have some of the following tests.
- Slit lamp biomicroscopy. This is when your doctor uses a special microscope to look for changes in your retina and macula. These may include a build-up of drusen (protein deposits) and other changes.
- Ocular coherence tomography (OCT). This is a type of scan that gives your ophthalmologist detailed pictures of the inside of your retina.
- Fluorescein angiography. In this test, a dye called fluorescein is used to show up blood vessels inside your eye. This can help your ophthalmologist to see which type of AMD you have, and how severe it is.
The treatments available to you depend on the type of AMD you have, and how advanced it is. Whichever type you have, there are changes you can make that may slow down the progression of AMD.
Slowing the progression of age-related macular degeneration
If you smoke, it's important to stop as this reduces the risk of your AMD progressing. If you need advice about stopping smoking, contact your local Stop Smoking Service (see further information).
Make sure you're eating a healthy, balanced diet, with plenty of leafy, green vegetables and fresh fruit. These foods provide certain substances that may help to slow the progression of AMD. There's no firm evidence to prove this yet, but making sure you follow a healthy diet is a sensible measure to take.
Your ophthalmologist may suggest you take a dietary supplement if there are signs that your AMD is starting to progress. These supplements contain antioxidants that may help to prevent further damage to your eye. They're not available on the NHS, but you should be able to buy them from most pharmacies. The benefit of taking these supplements might only be quite small, and there are risks involved too. Your ophthalmologist will discuss this with you.
Dry age-related macular degeneration treatment
There isn't currently anything doctors can do to treat or cure dry AMD. If you're diagnosed with this type, your doctor will talk to you about things you can do to slow any further decline in your eyesight. These are described in the section above. They will also talk to you about visual aids you can use to help you see more clearly.
Your doctor may refer you to support services that can help you adapt to having sight problems. There are also programmes that can help you live independently with AMD. See our FAQ below, How will I cope with age-related macular degeneration, for more information.
Your doctor will probably ask you to monitor your condition and report any changes in your symptoms as soon as possible.
Wet age-related macular degeneration treatment
Treatments for wet AMD work by stopping new blood vessels from growing in your eye. This can stop your vision from getting any worse, or may even improve your vision in some people. You’ll need to start treatment as soon as possible. If blood vessels grow for too long, they can scar your retina and cause permanent damage. If you have wet AMD, your doctor is likely to recommend that you have regular scans to monitor your condition.
Anti-vascular endothelial growth factor (anti-VEGF)
These medicines work by stopping new blood vessels growing. They're given as an injection into your eye. Your doctor will apply local anaesthetic eye drops or a gel to your eye before the injection to reduce any pain.
You’ll usually need to have an injection once a month for the first three months. Your doctor will monitor your response to the treatment and see whether you need to continue. You may need to have treatment and follow up appointments for a long time, usually at least a year or two. Around a third of people who have anti-VEGF treatment find that their vision gets better. Many people will maintain their current level of vision, and about one in 10 won't respond to the therapy (their vision may get worse).
Types of anti-VEGF medication include ranibizumab, aflibercept and bevacizumab. Your doctor will only suggest you try them if your vision hasn't fallen below a certain level, and treatment is still expected to give you some benefit.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) involves using laser treatment to destroy damaged areas of your eye. Your doctor will inject a special light-sensitive dye into your arm, which is taken up by the growing blood vessels in your eye. The laser activates the dye, which then destroys the abnormal blood vessels, without affecting the surrounding healthy tissue. PDT isn't suitable for everyone, but if your doctor recommends it, you'll have it in combination with anti-VEGF treatment.
AMD is an age-related disease, associated with your eyesight getting worse. The reason why only some older people seem to develop it is unclear. But there are some things that are known to be strong risk factors for AMD. These include the following.
- Your age. You’re more likely to develop AMD as you get older.
- Smoking. If you smoke, you’re two to three times more likely to develop AMD than a non-smoker. Your risk increases with the amount you smoke, and the number of years you've been smoking.
- Having a family history of AMD. You have a greater risk of developing AMD if a parent or sibling has had it.
The most important thing you can do to reduce your risk of developing AMD is to give up smoking if you smoke. Eating a healthy diet with plenty of fruit, vegetables and oily fish may also be helpful.
It's important to attend routine eye tests. This is an opportunity for your optometrist to pick up on early signs of the disease, which will give you the best chance of preventing it progressing further.
FAQ: Finding a cure for dry age-related macular degeneration How close are we to a cure for dry age-related macular degeneration?
Currently, there’s no cure or treatment for dry AMD. But there are many scientific research studies looking into this.
Scientists are looking for new treatments for AMD all the time. New treatments that are currently being investigated for dry AMD include the following.
- Monoclonal antibodies that may be able to halt the development of dry AMD.
- An implant of retinal cells into your eye, targeting the photoreceptor cells in your eye.
- Development of new formulations of dietary supplements that may be able to slow the progression of AMD.
- Implanted lens systems that may either magnify images on the macula, or move images onto an unaffected part of your eye. This is an experimental treatment and the benefits and risks of the procedure still aren't clear. They're suitable for only a small number of people and only available at certain hospitals where doctors have had the appropriate training.
All of these treatments need further research to see how well they work and how safe they are, before they can be recommended for general use. Your ophthalmologist may be able to give you more information about them.
FAQ: Coping with age-related macular degeneration How will I cope with age-related macular degeneration?
AMD affects everyone differently – it may be that your vision isn’t severely affected. But if you are experiencing vision loss, there is a lot you can do to make the most of the vision you have, and to live independently.
It's natural to feel upset or overwhelmed when you're first diagnosed with AMD. It can be helpful to talk to a counsellor about how you feel, and any worries you may have. Try contacting the RNIB for help in finding a counsellor – see details in our further information section below. Talking to other people in a similar position and sharing experiences may also help. Getting in touch with patient groups is a good way to do this. The Macular Society (details listed in the Further information section below) runs local groups throughout the country.
Your doctor can tell you about what low vision services are available in your area. These may be provided by social services, optometrists or voluntary groups. These services aim to help you live independently, by helping you make the most of the eyesight you have. They may be able to provide, and help you learn how to use various optical aids such as magnifiers and electronic devices. They can also provide advice on other things, such as how you may be able to use your peripheral vision for tasks such as reading.
You might want to consider whether you're eligible to register as sight impaired (partially sighted) or severely sight impaired (blind). This may allow you to have access to certain financial benefits and help with day-to-day living.
Having AMD doesn't automatically mean you won't be able to drive. This will depend on how severe your condition is, and whether your vision still meets the requirements set by the Driver and Vehicle Licensing Agency (DVLA). Check with the DVLA if you're unsure (see Further information).
AMD will never make you totally blind. This is because while AMD affects your central vision, you'll still have peripheral vision, or vision at the sides or edges of your sight. Dry AMD causes a very gradual loss in your central vision – usually over several years. If you have wet AMD, vision loss can happen more quickly – within weeks or months, if it isn’t treated quickly.
Having peripheral vision means that you should still be able to get around on your own. But you may need help to make the most of the vision you have. You may be eligible to register as blind or partially sighted.
Your ophthalmologist can refer you to low vision services to help you cope with your sight loss. This can help you to live independently and continue with most of your usual activities.
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- Retina anatomy. Medscape. emedicine.medscape.com, updated 7 December 2017
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- Age-related macular degeneration. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, January 2018
- Age-related macular degeneration. PatientPlus. patient.info, published 28 September 2016
- Age-related macular degeneration. BMJ Best Practice. bestpractice.bmj.com, last updated December 2017
- Examination of the eye. Patientplus. patient.info, published 5 October 2016
- Nursing patients with sensory system problems (eyes, ears, nose, and throat). Oxford handbook of adult nursing (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
- Age-related macular degeneration: guidelines for management. Royal College of Ophthalmologists, September 2013
- Shiroma HF, Takaschima AKK, Farah ME et al. Patient pain during intravitreal injections under topical anesthesia: a systematic review. Int J Retina Vitreous 2017; 3:23
- A study of an Encapsulated Cell Technology (ECT) implant for patients with atrophic macular degeneration. ClinicalTrials.gov. www.clinicaltrials.gov, last updated November 2016
- Miniature lens system implantation for advanced age-related macular degeneration. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, September 2016
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Reviewed by Pippa Coulter, Freelance Health Editor, March 2018
Expert reviewer Professor Simon Taylor, Consultant Ophthalmic Surgeon
Next review due March 2021
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